In the five years before COVID-19 reached Canada, long-term care homes across Ontario were hit with nearly three times as many outbreaks of respiratory infections than retirement homes in the province, documents show — illustrating longstanding vulnerabilities in the sector most devastated by COVID-19.

Year after year since at least 2015, annual respiratory pathogen bulletins compiled by Public Health Ontario showed long-term care homes vastly outpacing other institutional settings in terms of outbreaks of influenzas, rhinoviruses, coronaviruses, combined outbreaks and other infections.

Specifically, out of 8,670 respiratory infection outbreaks that were documented in Ontario institutions from Sept. 1, 2014 to Aug. 31, 2019 — including outbreaks in hospitals, correctional facilities, group homes, shelters and retirement homes, though not schools — 59 per cent were in long-term care. That translates to 5,118 individual outbreaks, which is nearly triple what was documented in retirement homes and more than seven times the number logged in Ontario hospitals during those five years. Per data from the ministry of long-term care and the head of geriatrics for several Toronto hospitals, Ontario has 626 long-term care homes and 770 retirement homes.

Retirement homes accounted for 20 per cent of the institutional respiratory infection outbreaks over that five-year period, while Ontario’s hospitals accounted for 8.2 per cent.

“There are these consistent, underlying systemic vulnerabilities,” Samir Sinha — the director of geriatrics for Toronto’s Mount Sinai and University Health Network hospitals, who has been tracking COVID-19 outbreaks for Ryerson’s National Institute of Ageing — told iPolitics. He pointed to issues around multi-bed rooms, especially in older homes, and the practice of staff moving between facilities that was halted in mid-April.

Other health association leaders offered similar assessments on Wednesday. “These issues did not just show up in February of 2020,” SEIU healthcare union president Sharleen Stewart said. “They’ve been here for a while.”

Since COVID-19 reached Ontario, its long-term care homes — like others across the country — have struggled to keep the virus at bay. As of Wednesday, ministry data shows at least 1,427 long-term care residents have died, as have five staff members. With elderly and often frail residents already vulnerable to the worst of the disease, issues like staffing shortages have raised alarm. Military members have been deployed to assist in hard-hit homes.

As of late April, epidemiological modelling released by the province showed a clear split between the general population, which was believed to have reached its peak of virus spread, and congregate settings, where the situation was expected to worsen. As opposition parties have called for a public inquiry, the province has announced that a commission will examine the issues that have arisen in long-term care, starting in September.

Awareness of systemic issues within the long-term care sector, at the provincial level, predated the arrival of COVID-19. A public inquiry into the sector, sparked by the murders perpetrated by former nurse Elizabeth Wettlauffer, concluded less than a year ago. The inquiry made 91 recommendations for long-term care in a report released last July, but that probe did not specifically examine data related to infection spread.

The five years of data on institutional respiratory outbreaks, contained in the public health bulletins, covers outbreaks in facilities like correctional institutions, group homes and shelters, in addition to long-term care and retirement homes. Collectively, that category accounted for 0.8 per cent of overall outbreaks, with 11.9 per cent of outbreaks at “unknown” locations. The data isn’t skewed by any one-year spikes, with long-term care accounting each year for somewhere between 56.2 and 64.6 per cent of Ontario’s documented institutional outbreaks.

While the issue hasn’t visibly worsened since 2014, according to the data shown, it hasn’t markedly improved either. Fewer outbreaks were recorded in Ontario’s long-term care homes last year, and in institutions overall, compared to the two years previous — but long-term care homes accounted for a higher percentage of the total.

“It certainly makes you think there’s been a certain amount of complacency,” Ontario Nurses’ Association president Vicki McKenna said in a telephone interview, when presented with the data collected over the last five years. “I don’t believe ‘it is the way it is, and we should just accept it.’ Those numbers are glaring.”

Sinha acknowledged that governments have shown an interest in efforts to improve the long-term care system. As it stands, he says, Ontario’s nursing homes include multi-bed rooms, which present a greater risk for infections spreading than in retirement homes with single occupancies. McKenna additionally noted that, while retirement homes house elderly residents, their residents tend to be more mobile and have fewer health complications.

But McKenna and others said the vulnerability of long-term care residents shouldn’t translate to an acceptance of increased respiratory outbreaks in that environment. The data from the five years before COVID-19 hit, she said, should be “a big awakening” to those involved with the sector. “We can’t accept it, certainly not any longer,” she said.

Public Health Ontario told iPolitics that questions about efforts to address the discrepancies in respiratory outbreaks between various settings would be within the purview of the provincial health ministry. Public health’s role, they said, was to provide scientific and technical information, as well as data analysis like the bulletins.

Asked whether the institutional respiratory outbreak data was on the minister’s radar prior to COVID-19, and whether any efforts were in the works to remedy the uneven distribution among settings, the Ontario Ministry of Long-Term Care did not provide information or comment to iPolitics by the time of publication on Wednesday.

Ontario opposition leader Andrea Horwath, meanwhile, said that numbers like the ones contained in the respiratory bulletins were only as valuable as the way they were analyzed and acted upon. “The reality is that there needs to be something done with that information,” Horwath said in a telephone call on Wednesday.

“Simply leaving it in a report is not good enough. Somebody in the Ministry of Long-Term Care, or Health and Long-Term Care, should have been flagging this to the government. I don’t know if they have or they haven’t, they did or they didn’t. But it certainly screams out for some kind of proactive response, which we know we didn’t see.”